不同病因所致心功能Ⅳ级心力衰竭患者血清脑钠肽水平观察
发布时间：2018-03-28 07:39
本文选题：脑钠肽 切入点：心力衰竭 出处：《承德医学院》2017年硕士论文
【摘要】：目的:检测不同病因所致的心功能IV级心力衰竭患者血清脑钠肽(brain natriuretic peptide,BNP)水平,评估BNP在不同病因所致心力衰竭诊断及预后评估中的意义。方法:1.研究对象:收集2014年06月至2016年01月期间,根据患者症状、体征、心脏彩超等检查确诊的不同病因所致慢性心力衰竭患者共计297例,按照美国纽约心脏病协会的分级方法均为心功能IV级,其中男150例、女147例,年龄(66.8±12.4)岁,根据心力衰竭病因共分为6个组,其中冠状动脉粥样硬化性心脏病组51例,高血压性心脏病组50例,风湿性心脏瓣膜病组41例,非风湿性心脏瓣膜病组56例,扩张型心肌病组52例,肺源性心脏病组47例。各组患者年龄、性别、吸烟史、血脂异常史、血压等方面比较差异无统计学意义(P0.05),具有可比性。排除标准:(1)急性心力衰竭;(2)肾小球滤过率60mL/min,且存在严重肾功能障碍(血肌酐250μmol/L);(3)合并2种及以上基础病因心力衰竭;(4)三尖瓣、肺动脉瓣病变的心脏瓣膜病;(5)梗阻性肥厚型心肌病;(6)甲状腺功能异常;(7)严重感染;(8)心肺复苏术后;(9)合并血液系统疾病;(10)恶性肿瘤。2.诊断标准:依据2012年欧洲心脏病学会(ESC)心力衰竭诊断治疗指南。3.血清BNP水平检测:297例患者入院时未经治疗前,抽取肘正中静脉血3ml,经EDTA抗凝处理,采用荧光免疫法测定血清BNP水平。4.统计分析方法:所得数据采用SPSS19.0统计软件进行处理,正态分布或近似正态分布的数据以(?)±s表示。各组均数间的BNP数据比较采用完全随机设计资料方差分析,若各组间均数整体差异具有统计学意义,进一步采用LSD法进行均数间的两两比较。计数资料采用χ2检验。p0.05为差别具有统计学意义。结果:冠状动脉粥样硬化性心脏病组、高血压性心脏病组、风湿性心脏瓣膜病组、非风湿性心脏瓣膜病组、扩张型心肌病组、肺源性心脏病组患者的血清BNP水平分别为(1513.9±1125.5)pg/mL、(1087.9±812.0)pg/mL、(636.0±821.0)pg/mL、(1171.8±935.6)pg/mL、(1462.4±988.6)pg/mL、(641.4±610.9)pg/mL。不同病因所致心功能IV级心力衰竭患者血清BNP水平存在显著差别(P0.001),其中,冠状动脉粥样硬化性心脏病组、扩张型心肌病组、高血压性心脏病组、非风湿性心脏瓣膜病组患者血清BNP水平均高于风湿性心脏瓣膜病组、肺源性心脏病组患者(P0.05);风湿性心脏瓣膜病组患者和肺源性心脏病组患者血清BNP水平比较差异无统计学意义(P0.05);冠状动脉粥样硬化性心脏病组、扩张型心肌病组患者血清BNP水平均高于高血压性心脏病组、非风湿性心脏瓣膜病组患者(P0.05);高血压性心脏病组患者和非风湿性心脏瓣膜病组患者血清BNP水平比较差异无统计学意义(P0.05);冠状动脉粥样硬化性心脏病组和扩张型心肌病组患者血清BNP水平比较差异无统计学意义(P0.05)。结论:不同病因心力衰竭患者血清BNP水平不同,其中扩张型心肌病组和冠状动脉粥样硬化性心脏病组患者血清BNP水平最高,高血压性心脏病组和非风湿性心脏瓣膜病组患者血清BNP水平次之,风湿性心脏瓣膜病组和肺源性心脏病组患者血清BNP水平最低。因此,以BNP作为诊断心力衰竭、评估病情、判断预后的指标时要考虑到不同病因。
[Abstract]:Objective: to detect the different etiologies of heart function in patients with grade IV of serum brain natriuretic peptide (brain natriuretic peptide heart failure, BNP) level of significance to evaluate BNP in the diagnosis and prognosis of heart failure caused by different etiology in. Methods: 1. subjects: during the period from 2014 06 to 2016 01 months, according to the patient's symptoms, signs, heart color Doppler ultrasound examination confirmed the different causes of chronic heart failure in patients with a total of 297 cases, according to the grading method of the New York Heart Association were NYHA class IV, male 150 cases, female 147 cases, age (66.8 + 12.4) years old, according to the etiology of heart failure were divided into 6 groups, including coronary atherosclerotic heart disease group of 51 cases, hypertensive heart disease group of 50 cases of rheumatic heart disease group 41 cases, non rheumatic heart disease group of 56 cases, 52 cases of dilated cardiomyopathy group, pulmonary heart disease group of 47 cases. The age of patients, Gender, smoking history, history of dyslipidemia, blood pressure and other aspects of the difference was not statistically significant (P0.05), comparable. Exclusion criteria: (1) acute heart failure; (2) the glomerular filtration rate of 60mL/min, and there are serious renal function (serum creatinine 250 mol/L); (3) with 2 and above the basic cause of heart failure; (4) three tricuspid valvular heart disease, pulmonary artery valve disease; (5) obstructive hypertrophic cardiomyopathy; (6) abnormal thyroid function; (7) severe infection; (8) after cardiopulmonary resuscitation; (9) in patients with hematological malignant disease (10);.2. diagnosis standard: Based on the 2012 European Society of Cardiology (ESC) heart failure diagnosis and treatment of serum BNP.3. guidelines: 297 patients with untreated before extraction, median cubital vein blood 3ml, EDTA after anticoagulant treatment, serum BNP levels were measured by.4. statistical analysis method with fluorescence immunoassay: the data by SPSS19.0 statistics soft Treatment of normal distribution or approximate normal distribution of the data in (?) + s. BNP data were used to compare between the number of completely randomized design ANOVA, if the differences are statistically significant differences, further using LSD method were compared between the number of 22. Count data using 2 test for.P0.05 was statistically significant difference. Results: the coronary heart disease group, hypertensive heart disease, rheumatic heart disease group, non rheumatic valvular heart disease, dilated cardiomyopathy group, the serum BNP level of pulmonary heart disease patients respectively (1513.9 + 1125.5) pg/mL, (1087.9 + 812) pg/mL, (636 + 821) pg/mL, (1171.8 + 935.6) pg/mL, (1462.4 + 988.6) pg/mL, (641.4 + 610.9) pg/mL. caused by different etiology of grade IV heart function in patients with congestive heart failure and serum level of BNP and there was a significant difference (P0.001), which, Coronary heart disease, dilated cardiomyopathy, hypertensive heart disease group, non rheumatic heart disease group were higher than the level of serum BNP in patients with rheumatic heart disease, pulmonary heart disease group (P0.05); rheumatic heart disease group were compared with pulmonary heart disease the serum BNP level of group no significant difference (P0.05); coronary heart disease group, dilated cardiomyopathy group were higher than that of serum BNP levels in patients with hypertensive heart disease group, non rheumatic heart disease group (P0.05); no significant hypertensive heart disease patients and non rheumatic valvular heart disease the serum BNP level of group differences (P0.05); no significant coronary heart disease group and dilated cardiomyopathy patients serum BNP level difference (P0.05). Conclusion: different etiology 蹇冨姏琛扮鎮ｈ，
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